Health Care For America Now

CBO numbers are in [pdf] on the Republican health care bill and guess what? It'll do nothing!

After 10 years, the Republican health care bill will reduce the number of uninsured by a paltry 3 million, leaving 52 million uninsured. The CBO goes on, "The share of legal nonelderly residents with insurance coverage in 2019 would be about 83 percent, roughly in line with the current share."

Compare this to the Democratic health care bill coming up for a vote, which the CBO says would cover up to 96% of Americans.

And in the area of reducing the deficit, typically a Republican mainstay, the CBO says the Republican bill would do less compared to the House bill up for a vote shortly.

Republicans will claim that the CBO says their bill will reduce premiums. The question, as Jon Cohn explains, is how:

By weakening or removing requirements that insurance cover certain services–everything from cancer screenings to mental health–the Republican bill would likely result in people getting insurance that covers less. That is, based on a quick canvassing of people who have read the report, the meaning of this passage:

The second source of change in average insurance premiums is changes in the average extent of coverage purchased. … With other factors held equal, insurance policies that cover more benefits or services or have smaller copayments or deductibles have higher premiums, while policies that cover fewer benefits or services or have larger copayments or deductibles have lower premiums. Provisions in the amendment that would reduce insurance premiums by affecting the amount of coverage purchased include the State Innovations program, which would encourage states to reduce the number and extent of benefit mandates that they impose, and provisions that would  allow individuals or affiliated groups to purchase insurance policies in other states that have less stringent mandates.

So, yes, the Republican health care bill will lower premiums overall. But many people in poor health will see their premiums go up. And many people will get lower premiums only because they’re getting inferior coverage.

Of course, as noted yesterday, the CBO implies the House bill will reduce premiums as well, while providing better coverage, though they haven't examined the question directly.

So let's review. The Republican bill would do nothing to change the number of uninsured in this country. It would reduce the quality of coverage you get, and sick people would pay more, to say nothing of continued denials for pre-existing conditions. And the bill would do less to reduce the deficit than the Democratic bill.

The Republican bill: 219 pages of wasted paper, all to preserve the status quo. And that's great news for the insurance industry.

Why do private, for-profit, Wall Street-run health insurance companies deny your care? Why do they drop your coverage if you get sick? Why do they raise your rates and limit your doctor-recommended treatments?

So they can make money.

One measure of how much money these private plans make is their "medical loss ratio," the amount of money they spend paying for the health care of their customers vs. the amount of money they pocket as profit. Obviously, if they pocket more money and spend less on care, they make larger profits and their Wall Street investors approve.

Since the insurance companies defeated health care reform last time around in 1993, their medical loss ratio has plummeted. As our premiums have skyrocketed, and we face more denials and rejections, the amount of your premiums private insurance companies spend on your care has dropped almost 15 points, from 95% to 81%. Compare that to Medicare [pdf], which has always spent almost 98% of the money it takes in on care:

This is just one of the many problems with private insurance. The relentless drive for profits and a lower medical loss ratio makes private insurers deny more care and find any way they can to spend less money on you and give more to their Wall Street investors.

This chart points to one of the advantages of a public health insurance option: More of the money you pay to it in premiums will go towards your care, seeing as the public option, like Medicare, won't need to lower its medical loss ratio to make a profit for Wall Street, not to mention increasing competition and improving everyone's care.

The Wall Street Journal, of all places, had the most accurate headline on the new Republican health care bill set to be unveiled by John Boehner, after months of waiting. The headline was: "GOP Health Bill Gives Insurers More Leeway."

The Wall Street Journal apparently thought that headline was too honest, and the article has subsequently dissapeared from their website, but the Internet has preserved it for us, in a slightly edited form, and the facts speak for themselves:

A House Republican health-care bill wouldn't seek to prevent health insurance companies from denying sick people insurance, Minority Leader John Boehner (R., Ohio) said Monday.

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The bill would allow insurance firms to sell policies across state lines, permit small businesses to pool together to bring down costs they face, implement changes to medical malpractices, and give state governments more flexibility to pursue rule changes in their states.

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Boehner also said Monday that the Republican plan wouldn't include tax credits for people who buy insurance individually rather than through their employer. He cited the cost of providing those credits as a reason why they wouldn't be included.

Apparently, the forthcoming GOP health care bill operates on the principle that if it's good for insurance companies, it must be good for us.

The Republican bill runs the table on provisions that will increase insurance company profits.

• Make more money by denying care? Check.
• Make more money by ending insurance policies when someone gets sick and actually needs to use the care they paid for? Check. (At least according to the original version of the Wall Street Journal article.)
• Allowing insurers to move to the least-regulated states and sell their junk insurance to the rest of the country? Check.

There's no attempt to expand coverage to people who are dying without it, that would be too costly. And no attempt to shield people from insurance company abuses like denial of care.

I'm not sure what this bill does do, beyond funnel more money to insurance companies. As Speaker Pelosi's blog illustrates, in comparison to the plan on the table in the House, this new plan is just a bunch of no:

The Republican health care plan: Where the insurance companies win and you lose.

Why is it that virtually every time the Lewin Group has come out with a study this year, the conclusion argues against health care reform?

The right has made an entire campaign out of using Lewin studies that distort the public health insurance option. By using assumptions that will get the results the group paying for the research wants - even if those assumptions have nothing to do with reality - Lewin delivers what it's being paid for. The big example this year was the Lewin report that claimed more than 100 million people would enroll in a public option, a result parrotted most recently by Republican senators during the Senate Finance Committee debate. Lewin got those result by modeling health care proposals that didn't have an insurance exchange and allowed all businesses to enroll in the public option, assumptions that were not reflected in any of the actual health care reform proposals.

Lewin's latest study claims that health care reform (specifically the Senate Finance Bill, but broadly applicable) would increase health care spending overall in this country. The conclusion of this study eerily echoes the conclusions of the fatally flawed insurance industry study which threatened to raise rates if health reform was passed. The industry has been on a campaign to blame health reform for driving premiums up, while at the same time driving premiums through the roof themselves.

Why do all of Lewin's studies seem to come to the same conclusion? Because the Lewin Group is a wholly owned subsidiary of UnitedHealth, and insurance company.

As the Washington Post points out, this salient fact isn't often noted in the media or by the conservatives who use Lewin's flawed numbers to fight against health care reform:

To Rep. Eric Cantor (Va.), the House Republican whip, it is "the nonpartisan Lewin Group." To Republicans on the House Ways and Means Committee, it is an "independent research firm." To Sen. Orrin G. Hatch (Utah), the second-ranking Republican on the pivotal Finance Committee, it is "well known as one of the most nonpartisan groups in the country."

Generally left unsaid amid all the citations is that the Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers.

More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied UnitedHealth and other insurers with data that allegedly understated the "reasonable and customary" doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.

Lewin is not independent. As a wholly owned subsidiary of UnitedHealth and a corporate hit man-for-hire, the companies that commission Lewin studies have the option of burying reports that don't give them their desired outcome. This isn't speculation, either. John Sheils, Lewin's chief spokesman and Vice President, admitted this directly.

And Lewin is not non-partisan. UnitedHealth, it's parent company, has a history of giving to Republicans, including $1.5 million to help host 2008's Republican National Committee Convention in Minneapolis.

The Lewin Group always reaches the same conclusion - that health care reform is bad - because it's own by the same insurance companies spending millions to fight reform. No wonder their latest report looks like the insurance industry's - it is.

It's hard to make the case that private insurers are simply out to protect their profits any better than this:

Maybe it was just lousy timing, but many customers of Blue Cross and Blue Shield of North Carolina are ticked off at the mail they've received recently from the state's largest insurer.

First, they learned their rates will rise by an average of 11 percent next year.

Next, they opened a slick flier from the insurer urging them to send an enclosed pre-printed, postage-paid note to Sen. Kay Hagan denouncing what the company says is unfair competition that would be imposed by a government-backed insurance plan. The so-called public option is likely to be considered by Congress in the health-care overhaul debate.

For those who need a reminder, a public health insurance option would compete directly with private insurers like Blue Cross, and a public health insurance option wouldn't have to turn a profit, forcing Blue Cross's rates down.

Blue Cross extorts more money from their customers with one hand with an 11% rate increase - they do control a whopping 53% of the market in North Carolina after all [pdf], and 98% of the individual market and billions in reserve dollars, so they can get away with that kind of thing - and with the other, tries to enlist these same customers to fight against something that would Blue Cross's rates and profits.

Fortunately, the good people of North Carolina are having none of it:

Indignant Blue Cross customers, complaining that their premium dollars are funding the campaign, have called Hagan's office to voice support for a public option. They've marked through the Blue Cross message on their postcards and changed it to show they support the public option, then mailed the cards.

"I hope it backfires," said Mark Barroso, a documentary film maker in Chatham County who is a Blue Cross customer and recipient of the mailings. "I'm doing everything I can to make sure it does."

Beth Silberman of Durham said she "went sort of bonkers" about the mailing. "You're hostage to them, and then they pull this," she said. "My new premiums are funding lobbying against competition. It's pretty disgusting."

Check out one of the "corrected" postcards:

It's a true grassroots effort, and one that's already getting the attention of Senator Hagan's office.

Thank you, Blue Cross, for making the point for us so well. Whatever the insurance companies want, you should want the opposite. If they win, you lose.

This morning, AHIP, the insurance industry's front group and lobbying arm, said this:

Steve Champlin, a lobbyist for the Duberstein Group who represents AHIP, declared that the road to a bipartisan health care reform bill was, essentially, dead. And he urged GOP members to keep it that way.

"There is absolutely no interest, no reason Republicans should ever vote for this thing. They have gone from a party that got killed 11 months ago to a party that is rising today. And they are rising up on the turmoil of health care," said Champlin. "So when they vote for a health care reform bill, whatever it is, they are giving comfort to the enemy who is down."

This afternoon, AHIP said this:

AHIP President and CEO Karen Ignagni today affirmed health plans’ strong support for comprehensive, bipartisan health care reform that covers all Americans, improves quality, and makes care more affordable.

One of these statements represents AHIP's true position, and one is a lie. I think you know which is which.

Meanwhile, hundreds rallies outside of AHIP's conference in DC in support of health reform and a public health insurance option, demanding Karen Ignagni, the insurance industry's top lobbyist, meet with seven families who's lives have been turned upside down by insurance company bad practices and who traveled thousands of miles to be in DC today. Ignagni never showed.

Here are the pictures:

The insurance companies have been playing a game with the American people for over a year now.

It started with the "listening tour" AHIP - the insurance industry's front group and lobbying arm - put on last fall leading up to the election. As we documented thoroughly, while AHIP said it was out listening to the public on health reform, it actually spent months playing hide and seek with real people, and pressure from us forced them to cancel and curtail their plans.

Then, from the results of this sham listening tour, the insurance companies put out their "reform" plan, which largely mirrored defeated Republican candidate John McCain's plan. The insurance industry's plan was roundly defeated in the November election, which should tell you how closely AHIP "listened" to the American public.

Into 2009, the insurance industry continued their attempts to fool the American people. They said over and over that they were for health care reform. Karen Ignagni, AHIP's top lobbyist, said so to the President. In every press conference and every TV appearance, this was the message that they tried to put out.

Meanwhile, the industry was spending millions per day lobbying against reform, particularly the public health insurance option. All of this is part of the strategy Think Progress diagrammed months ago, involving a public charm offensive and multiple anti-reform front groups.

Lately, as real health care reform begins to look more likely to pass, the insurance companies have taken to saying they support "bipartisan" reform, whatever that means.

But today, the veil has finally come off this charade. Another one of the insurance industry's top lobbyists, Steve Champlin (who also works for AHIP), told Republicans Members of Congress not to vote for health reform under any circumstances:

"There is absolutely no interest, no reason Republicans should ever vote for this thing. They have gone from a party that got killed 11 months ago to a party that is rising today. And they are rising up on the turmoil of health care," said Champlin. "So when they vote for a health care reform bill, whatever it is, they are giving comfort to the enemy who is down."

"Long before the Republicans discovered that the House bill was a strategy to kill seniors and all that kind of stuff the plan was already unpopular," he added, underscoring why Republicans shouldn't attach themselves to the legislation.

The remarks came during the opening session of AHIP's annual State Issues Conference in which both Champlin and his co-panelist seemed to concede that reform would pass and will include a variation of a public option for insurance coverage.

The industry that treats rape as a pre-existing condition is finally coming clean. Their message: Republicans should kill health care reform, otherwise they will be giving comfort to the "enemy."

I'm glad the insurance companies are finally coming clean that they're against health reform and that they've always been against health reform. It's slightly more honest of them. I'm also glad that the industry is in town for their conference.

Today, Health Care for America Now, along with hundreds of supporters and all of our partners in DC, will be at the AHIP State Issues Conference at the Capitol Hilton at 3:00 pm. We're bringing seven families who's lives have been torn apart by the insurance industry to confront Karen Ignagni. If you're in the area, come join us. And if not, sign the petition to stand with us.

The insurance industry will always be against health reform, because it will cut into their profits and make America healthier. And now they're admitting it.

Tomorrow, Susan Pearl is coming to Washington, D.C.

She's coming on behalf of her son, Ian Pearl. Ian survives on a ventilator, a lasting condition stemming from respiratory collapse he suffered in 1991. His premiums from a Guardian Insurance policy Susan bought in 1981 have risen from $100 per month to over $3,000 per month. And now, Guardian is eliminating his policy, calling him a "dog" in internal documents. In Ian's own words:

I am not a "dog." That's what health insurance executives called me because I have a disease. I'm also not a "trainwreck," another term they used for members like me.

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After decades of medical emergencies, we still weren't prepared for the latest crisis — this one created by the same insurance company that once saved my life. Guardian abruptly withdrew our health plan from all policyholders in New York where my father's business is based. Guardian offered a 'replacement' plan with low benefits and no home nursing benefits. They knew that I would never survive with such a plan, but they didn't care.

Suspecting that this action was related to the high cost of my care, we filed a lawsuit and have asked the U.S. Department of Health and Human Services to enforce existing federal laws and require Guardian to continue my health plan. Without federal intervention, I will lose this insurance, and that would be a death sentence.

Our lawsuit uncovered insurance company documents that confirmed my suspicion that I'm a target of discrimination. The documents revealed Guardian had compiled a "hit list" of its costliest members, including patients with muscular dystrophy, multiple sclerosis, brain injury, and paralysis. Guardian executives referred to us all as "dogs" and "trainwrecks," and they debated how and when to dump us from the rolls. Laws prohibited the cancellation of the individual members with serious chronic health problems, so Guardian opted to cancel the plan for all members of this specific health plan in New York, an action that violates federal law.

Instead of living up to their obligations to Ian, and because they can't just recind Ian's coverage, Guardian decided they could make more money if they discontinued the entire product line, cutting off everyone on this plan in the state of New York, an action that's perfectly legal.

Without this plan, which will be taken away December 1st, Ian faces bankruptcy. The care that keeps him alive will cost him $700,000 per year. All because of Guardian's greed.

Susan Pearl is coming to D.C. tomorrow on behalf of Ian, and representatives from 7 other families, all victims of the insurance industry, will be there as well. Why? Because America's Health Insurance Plans (AHIP), the insurance industry front group and lobbying arm, is having a conference in D.C. and all the insurance company CEOs will be there.

These seven families have sent a letter to Karen Ignagni, AHIP's top lobbyist, demanding a meeting with her so she can hear these stories and understand exactly what the companies she represents do to people. From the letter [pdf]:

We have lost siblings who could not get health insurance coverage due to pre-existing conditions. We have been overcharged, only to have our policies cancelled when our health care needs became less profitable for your members. We have been given the runaround in the midst of hospitalization and been forced to declare bankruptcy due to medical bills that your companies refused to cover. We have had to move back in with parents as medical expenses swallowed up our salaries and our savings.

While only seven of us will be at the Hilton on Thursday, we speak for millions who cannot obtain health insurance or who have coverage but still cannot get needed medical services.

Ms. Ignagni, we are not simply claims to be denied. We are siblings and parents and survivors who believe you should look us in the eye, hear our stories, and understand what you are lobbying against.

We'll all be at the Capitol Hilton in Washington, D.C. at 3:00 pm tomorrow. If you're in the are, you should join us. (Click here for details and to RSVP.) Karen Ignagni, you made $1.58 million in 2007. You can spare a few minutes to look these people in the eye and tell them why you're lobbying to protect corporate greed.

We expect to see you there.

When it comes to health care, women really feel the pain. According the National Womens' Law Center, women are denied fair health care every day:

Being a woman is not a pre-existing condition.

But, as NWLC uncovered in our groundbreaking report, women are regularly denied coverage for "pre-existing conditions" including pregnancy, a previous C-Section or past domestic abuse. Insurance companies charge women as much as 48% more for individual health care coverage than men. And it is expensive, difficult and in some states impossible for women to find coverage for maternity care when purchasing their own health insurance plan.

The depths to which insurance companies will sink to deny women health care are almost unfathomable. Today a woman testified before the Senate because she was denied health insurance as a result of a c-section — unless she wanted to permanently sterilize herself:

Today, at Sen. Mikulski's HELP Committee hearing "What Women Want: Equal Benefits for Equal Premiums," we met Peggy Robertson. Peggy is a mother of two young boys, living in Colorado with her husband. Over the past few years, Peggy and her family have faced not one but two shocking cases of insurance company abuse. First, in 2007, Peggy was denied coverage by Golden Rule insurance, a subsidiary of UnitedHealth Group (the largest insurance company in the US), because of a previous c-section birth. What happened next is shocking (Sen. Mikulski called it "bone-chilling" and "morally repugnant"): Golden Rule said they would cover Peggy if she agreed to be sterilized. Watch the video of her story on the SEIU Blog.

It's time to end these outrageous practices once and for all. I am sick of it. For a clearinghouse of all things health care and women go to "Women and Health Care Reform" and take action today.

Yesterday, Majority Leader Harry Reid testified in support of a bill championed by Senator Leahy to repeal the anti-trust exemption health insurance companies currently enjoy. The bill has received a ton of support:

Sen. Chuck Schumer (D-N.Y.) on Wednesday called for an amendment to the health care reform bill that would remove the long-standing antitrust exemption for insurers, echoing a push by other Democrats to crack down on the industry.

“The health insurance’s antitrust exemption is one of the worst accidents of American history," Schumer said. "It deserves a lot of the blame for the huge rise in premiums that has made health insurance so unaffordable. It is time to end this special status and bring true competition to the health insurance industry."

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Senate Majority Leader Harry Reid (D-Nev.) added his support to repealing the exemption at the Leahy hearing. “It’s something that should have been done a long time ago,” Reid said.

As for insurance companies, “There isn’t anything we could do to satisfy them in this health care bill. Nothing,” Reid said. “They are so anti-competitive. Why? Because they make more money than any other business in America today. . . .What a sweet deal they have.”

The exemption, known as McCarran-Ferguson, cedes regulatory control of the industry, on the business side, to individual states. But repealing the antitrust exemption would give the federal government more authority to oversee the business side of health insurance companies — something states now have the sole authority to monitor.

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Leahy’s bill would repeal the exemption established in the 1945 McCarran-Ferguson Act for any companies engaged in price fixing or bid rigging — which are both already illegal. He has introduced similar legislation in other Congresses, including a broader repeal of the underlying law. Reid is a co-sponsor of the current bill.

In the House, where Democratic leaders are exploring the issue further, Judiciary Committee Chairman John Conyers (D-Mich.) has introduced legislation that would essentially end McCarran-Ferguson and give the federal government the right to regulate insurers at the national level.

So, what would this repeal do? In testimony on the bill yesterday, Christine Varney, the government's top anti-trust lawyer, said:

The McCarran-Ferguson Act antitrust exemption is very expansive with regard to anything that can be said to fall within “the business of insurance,” including premium pricing and market allocations. As a result, “the most egregiously anticompetitive claims, such as naked agreements fixing price or reducing coverage, are virtually always found immune.”

Concerns over the exemption’s effects are especially relevant given the importance of health insurance reform to our nation. There is a general consensus that health insurance reform should be built on a strong commitment to competition in all health-care markets, including those for health and medical malpractice insurance. Repealing the McCarran-Ferguson Act would allow competition to have a greater role in reforming health and medical malpractice insurance markets than would otherwise be the case.

There is a ton of evidence that premium price fixing and backroom deals to preserve market share between competitors occur regularly today.

Health Care for America Now's report [pdf] on insurance industry absuses documents how Blue Cross Blue Shield in Massachusetts and a big hospital made a deal to increase payments to providers, and providers made a deal to not allow any other insurer to pay them less. Thus, Blue Cross raised their rates, leading to a period of skyrocketing premium increases in Massachusetts, the hospital got rich off their locked in payments, and other hospitals and insurers in the state had to scramble to keep up. In all, people had to pay more, and those increased premiums were passed along to the hospitals in on the deal.

This kind of price fixing and deal making is absolutely illegal in other businesses, but in the insurance industry, because of their anti-trust exemptions, they're allowed to screw customers without repercussions.

Similarly, Health Care for America Now found that 94% of insurance markets in this country are "highly concentrated," a Department of Justice term that means these markets are at risk for monopoly. For example, in Arkansas [pdf], Blue Cross Blue Shield controls 75% of the market, a level of concentration that would raise anti-trust lawsuits in any other industry.

These kinds of market concentrations were caused by years of mergers, mergers that would never have been allowed under normal anti-trust rules. And this market concentration is a huge driver of skyrocketing costs.

Ending the anti-trust exemption would be a huge start towards ending these abuses.

The insurance industry needs two things: Real competition and an end to their anti-trust exemption.

Price fixing, backroom deals, collusion, and market-concentrating mergers should once again be illegal in health insurance. And we need a public health insurance option to ensure insurance companies follow the rules set out for them.

Anything less and we'll get more of what we have now - skyrocketing prices and anti-competitive dealmaking resulting in more medical bankruptcies for Americans.